What is the role of a Nurse Case Manager in New York State Workers’ Compensation?
A nurse case manager (NCM) plays a key role in coordinating medical care for injured workers while ensuring cost-effective treatment and compliance with Workers’ Compensation guidelines. Their primary responsibilities include:
- Medical Oversight: Monitoring the injured worker’s treatment plan to ensure it aligns with medical guidelines and facilitates recovery.
- Care Coordination: Acting as a liaison between healthcare providers, the injured worker, the employer, and the insurance carrier to streamline communication.
- Return-to-Work Planning: Assisting in developing a plan for the injured worker’s return to suitable employment, either in their previous role or in a modified capacity.
- Ensuring Compliance: Ensuring that medical treatments follow New York’s Workers’ Compensation Medical Treatment Guidelines (MTGs) and obtaining necessary authorizations.
- Cost Containment: Helping manage medical expenses by guiding injured workers toward appropriate care and avoiding unnecessary treatments.
- Case Documentation: Keeping detailed records of medical progress, treatment authorizations, and any barriers to recovery.
While NCMs may offer recommendations, they do not make medical decisions, and their role must adhere to NY Workers’ Compensation Board (WCB) regulations, ensuring that the injured worker's rights are protected.
Involving a NCM at the onset of the claim can lead to a better outcome with speedier recoveries and the potential for the claimant to return to work. A NCM interfacing with the claimant – with the consent of counsel if the claimant is represented – is important to show the claimant that someone cares and can listen to their concerns about medical treatment and recovery.
Let Asch Workers’ Comp Strategy assist you in getting started with NCMs.